Paternal health in the first 12-13 years of the ALSPAC study

The Avon Longitudinal Study of Parents and Children (ALSPAC) collected information from the enrolled pregnancy onwards to identify features of the environment in which the study child was brought up. Among data collected were features concerning the health of the mothers’ partners – generally the study father. This was an important feature since the father’s physical and mental health can have a long-term effect on the family. In this Data Note we describe the data available on the father’s health from pregnancy until 12 years after the offspring was born. Not only is this a valuable addition to the environmental information available for studies of the child’s development and the mental health of the mother over time, but it will provide a useful description of the father himself during adulthood.


Introduction
The Avon Longitudinal Study of Parents and Children (ALSPAC) was designed to assess ways in which the health, well-being and development of the child was affected by the environment in which they grew up (Boyd et al., 2013;Fraser et al., 2013;Golding et al., 2001).One of the environmental features on which data were collected included the physical and mental health of the mother's partner.These data, which were collected at various stages during pregnancy and the child's early life, provide information which will be valuable in regard to the study's initial aims, but also provides a useful longitudinal resource concerning the health and wellbeing of fathers over time.Thus, in this Data Note we describe the physical and mental health of the mother's partner for the period from the middle of pregnancy until 12-13 years after the birth of the study child.All the data were collected by questionnaire -from both the mother's partner (for simplicity hereafter referred to as the study father), and from the study mother -in regard to the health of her partner.The data are available to interested researchers.

Material and methods
The ALSPAC sample Pregnant women residents in Avon, UK with expected dates of delivery 1st April 1991 to 31st December 1992 were invited to take part in the study.The initial number of pregnancies enrolled was 14,541 (for these at least one questionnaire has been returned or a "Children in Focus" clinic had been attended by 19/07/99).Of these initial pregnancies, there was a total of 14,676 fetuses, resulting in 14,062 live births and 13,988 children who were alive at 1 year of age.

Details of study father (mother's partner)
There are several features to note: (i) The mother was asked at each stage from pregnancy until the child was aged 12 years, to hand a questionnaire to her partner if she was happy for him to take part.This included its own reply-paid envelope so that this could be returned by the partner in confidence.
(ii) The mother was asked to define her partner -and was told that it was not essential that this be the biological father of the child.However, for simplicity her partners are referred to throughout this paper as the study fathers, regardless of their gender or parental status.
(iii) The fact that some of the study fathers are not the biological father is important to note -but it was intentional that the study took account of the characteristics of the person the mother looked to as her partner and who, more often than not, took the place of the child's father.Partners may change over time, but information on this is documented elsewhere (see details of the PZ file in the ALSPAC Data Dictionary).
(iv) It should be noted that the data were collected relative to the age of the study child; thus, where there is more than one study child, the father will have two entries.This may be important to keep separate when considering the associations with child outcomes, as well as with those of the father.The 52 instances where the fathers are related to two pregnancies can be distinguished using the variable pz_mult.It should be noted also that, for multiple births such as twins, the parents (mothers and fathers) each received only one questionnaire per time point.This is in contrast to data collected on the children themselves for which there were individual questionnaires related to each child.
(v) Information is available at most individual timepoints to distinguish the fathers who lived with the mother, those who were married to her, those who were not male and those who considered that they were the study child's biological father.

The presentation of the information on data available
The documentation below concerns the data that were collected and for which the frequencies of responses were published online in 2021 in the released data files published on the ALSPAC website Researchers | Avon Longitudinal Study of Parents and Children | University of Bristol.The actual numbers available may be slightly lower than shown since, over time, a very small number of participants withdrew consent for their data to be used.The tables in this Data Note include the variable name, the time after delivery that the questionnaire was administered, the numbers of participants responding to the specific question, and the % responding to each category after any missing responses have been excluded.Where available, responses from the study mother concerning the father's health are also included.
We recommend that researchers wishing to use these data always refer to the actual question used as these sometimes changed slightly between questionnaires.The best way to do this is to refer to the questionnaires as published in the ALSPAC Data Dictionary and view the copy of the actual questions asked as well as the ways in which they have been coded as described in the relevant documentation.http://www.bristol.ac.uk/alspac/external/documents/ALSPAC_Data_Dictionary.zip The data collected are described hereafter as follows: (1) general measures of health; (2) specific aspects of physical health; (3) psychiatric and neurological conditions; and (4) other health

Amendments from Version 1
As the reviewers have recommended, we have added two paragraphs to the Strengths and Limitations section of the Discussion.The first (second paragraph) adds caveats to cover the points made by Reviewer 1 concerning the problems in using EPDS for measuring depression in men and added a reference.
The second (penultimate) paragraph on the importance of considering paternal health and well-being in longitudinal family studies.
Any further responses from the reviewers can be found at the end of the article data available.For the non-clinician, we have described the condition(s) briefly under each section.

General measures of health 1.1 Subjective measures of health
Subjective measures of health are frequently collected in questionnaire-based studies and self-reported ill health has often been shown to be a good predictor of long-term adverse consequences (including mortality) (Sajjad et al., 2017).In ALSPAC, information on how healthy the study father was feeling was collected at various times from both the mother (8 time points from pregnancy to 12 years after the child was born) and the father (8 time points from 8 months after the child was born).In general, most of the fathers were reported as being fit and well, but it is notable that mothers increasingly reported them to be 'often unwell' or 'hardly ever well' over time.This was not apparent among the fathers' own reports which was likely due to those who were unwell not being given the questionnaire to complete (Table 1.1).

Reports of (non-specific) illness
The life events inventory administered at 9 intervals to both the mother and father included a question on whether the father had been ill (or very ill) during the period of time considered, and if so, how much it had affected the respondent.Table 1.2 shows that the mother reported that her partner had been ill for between 11 and 20% of the time periods.However, the father himself reported illness far less frequently (3 -6%), perhaps not surprising as the wording of his life event scale concerned whether he was 'very' ill.There was little evidence of increasing or decreasing rates of illness over time.

Hospital admissions
Hospital admission data was also collected as part of the father's life event scales, but her partners' admissions were not included in the mother's scales, The available information is described in Table 1.3.The data are non-specific and do not have any accompanying details such as whether or not any admission was an emergency, the reason for admission or length of stay.

Use of regular medication
One further non-specific measure of general ill-health concerns whether the father was taking medication regularly for health reasons.This was asked on 3 occasions and shows a sharp increase from 13.6% responding affirmatively during the index pregnancy to 23.5% 11 years later (Table 1.4).

Conditions resulting in joint and skeletal pain 2.1a. Arthritis
Arthritis is the swelling and tenderness of one or more joints.
The main symptoms are joint pain and stiffness, which typically  worsen with age.The most common type of arthritis is osteoarthritis.The prevalence of a history of arthritis in the fathers increased over time from 4.5% during the index pregnancy to 9.2% eleven years later (Table 2.1aa).
It can be seen that a similar rise in prevalence of consultations for the disorder occurred gradually over time, with similar rates being reported by mothers and their partners (Table 2.1ab).

2.1b. Rheumatism
Rheumatism is a term that people often used in the past when describing pain and other symptoms affecting the muscles and joints.Healthcare professionals tend not to use this term, but they use similar ones, such as "rheumatoid".When people use the term, they often mean Rheumatoid arthritis, which is an inflammatory autoimmune condition that leads to swelling in the joints.Compared with arthritis the pattern for rheumatism showed a less consistent increase over time, changing from 4.1% at the time of pregnancy to 4.5% after a further 11 years (Table 2.1ba).The breakdown by short time periods appears to show an increase over time, but it should be remembered that comparing the rates in Table 2.1bb is prone to error since the time intervals are often not comparable.

2.1c. Back pain
Back pain was recorded on a number of occasions, but its description often varied slightly -for example with inclusion of terms such as slipped disc.The prevalence of back pain was very commonly reported by fathers, especially when considering claims of pain occurring recently.This varied from 19% to 28% over a period of 12 years (Table 2.1ca).The paternal reported frequency of back pain showed no consistent variation (Table 2.1cb), but maternal report did show an apparent increase over time (Table 2.1cc).

2.1d. Other joint aches and pains
The frequencies with which the fathers reported knee pain, neck ache or shoulder ache are shown in Table 2.1d.The specific aches/pains that were reported as always present increased over time, but at no point exceeded 3% of the population of fathers.

Respiratory conditions 2.2a. Asthma and wheezing
Asthma is a condition in which airways are narrowed and swollen and may produce extra mucus.This can make breathing difficult and trigger coughing, a whistling sound (wheezing) when breathing out and shortness of breath.For some people, asthma is a minor nuisance; for others, it can be a major problem that interferes with daily activities and may lead to a life-threatening asthma attack.
Fathers were asked on three occasions whether they had ever had asthma, distinguishing between occurrences during the previous year and earlier in time (Table 2.2aa).There is some evidence that asthma increased over time (6.3% reported in pregnancy compared to 9-10% later).The frequency with which fathers reported wheezing with whistling on the chest was collected at the same three time points, and such a history varied from 18.4% to 16.8% over time, but with no indication of any increase (Table 2.2ab).
The occurrence of asthma like symptoms in the father was also asked of both parents covering 7 specific periods of time.This involved asking about 'asthma or wheezing' -and whether this had resulted in a clinical consultation.The results (Table 2.2ac) indicate that the mother was more likely than the father to report that he had consulted a doctor for the condition, but she was far less likely than he was to report the condition if he had not visited a doctor.Consequently, the father was far more likely than the mother to report that he had this problem.Comparing reports for the same periods of time -for example, taking the period from birth to 8 months later the mother reports asthma or wheezing for 7.4% of the fathers compared with 13.8% reported by the fathers themselves.

2.2b. Breathlessness
On three occasions the fathers were asked whether they had experienced attacks of breathlessness and if so, how frequently within the previous two years (Table 2.2b).There was little change in prevalence over the 12 years covered.

2.2c. Bronchitis
Bronchitis is an inflammation of the lining of the bronchial tubes.It may be either acute or chronic.Acute bronchitis often develops from a cold or other respiratory infection and is common and usually resolves within 10 days.Chronic bronchitis is more serious; it consists of a constant irritation or inflammation of the lining of the bronchial tubes and is often due to smoking.Both the study mothers and their partners (the study fathers) were asked to state whether the father had had bronchitis during seven specified periods of time -and to state whether a doctor had been consulted for the problem (Table 2.2c).Similar patterns of reply occurred for each.

2.2d. Cough
During the same specified times, each parent was asked whether the study father had had a cough or cold.Not surprisingly, the proportions reporting positively were high, with overall rates depending on the length of time covered.Relatively few of those with coughs and/or colds had consulted a doctor (Table 2.2da).
Timing of coughs was collected at three time points: during pregnancy, and at 8 and 11 years later.The fathers were asked whether they coughed often during the night and on waking (Table 2.2db).There was a suggestion that the proportion of fathers reporting often coughing on waking reduced over time.
There was no similar trend for often coughing during the night.

2.2e. Influenza
Each parent was asked as to whether the father had had influenza in specific periods of time.The incidences reported were similar, both for consultation of a doctor and with no such consultation (Table 2.2e).

Hay fever and other allergies
Hay fever, also called allergic rhinitis, causes cold-like symptoms which often include a runny nose, itchy eyes, congestion, sneezing and sinus pressure.It is caused by an allergic response to an airborne allergen such as dust or pollen.
Fathers were asked on three occasions whether they had hay fever in the past year or if not then, in the past but not the previous year; approximately a third responded positively (Table 2.3aa).At the same times, they were asked whether they had experienced three common symptoms of hay fever: frequent sneezing attacks, runny nose and watery eyes.Approximately 30% reported sneezing attacks, 60% frequent runny nose, and a third frequent watery eyes.Reports of often having these three signs reduced over time (Table 2.3ab).

Specific allergies
Allergies occur when the body's immune system reacts to a particular substance as though it's harmful.The most common allergens are pollen (especially to trees and grasses), mould, dust mites, pets (especially cats and dogs), and a variety of foods (especially nuts and peanuts).Individuals with allergies often also have asthma and eczema.
The father was asked about allergies on the same three occasions as for the signs of hay fever (Table 2.3b).This indicated that about a third reported having an allergy, with pollen and dust being the most common.It should be noted that only 4-5 specific allergens were enquired, but there was an opportunity for the father to indicate 'other' and write in other allergens.The relevant text descriptions are available for interested scientists to code.

Skin conditions 2.4a Eczema
Eczema, also known as atopic dermatitis, is a condition that makes the skin red and itchy.It is common in children but can occur at any age.It is long lasting (chronic) and tends to flare periodically.It may be accompanied by asthma or hay fever.
The father was asked on three occasions (during the study pregnancy and 8 and 11 years later) as to whether he had a history of eczema.Positive responses were received ranging from 13.5% during pregnancy to 20.8% eight years later (Table 2.4aa).
In parallel both the mothers and the fathers were asked about experience of eczema by the father (Table 2.4ab).Answers from both parents showed similar rates, varying from approximately 6-8% stating that the father had had eczema in the relevant period of time.

2.4b. Psoriasis
The skin disease psoriasis causes a rash with itchy, scaly patches, most commonly on the knees, elbows, trunk and scalp.It is a long-term (chronic) disease with no known cure.It can be painful, interfere with sleep and make it hard to concentrate.The condition tends to go through cycles, flaring for a few weeks or months, then subsiding for a while.Common triggers in people with a genetic predisposition to psoriasis include infections, cuts or burns, and certain medications.
Very few fathers reported psoriasis (3-5%); most of those who had had psoriasis reported that they had had the condition in the past year (Table 2.4ba).A similar picture was seen when looking at the mothers' and fathers' reports for certain periods of time, with similar rates being reported by each parent.However, mothers reported that about half the affected fathers had consulted a doctor for the problem compared with less than a third of the fathers at each point in time (Table 2.4bb).

2.4c. Dermatitis
Dermatitis is a general term that describes a common skin irritation.We have used it here to cover the answers to the description of a dry itchy rash.On three occasions the study fathers were asked how often they had had such a rash in the past two years.It can be seen from Table 2.4c that about a fifth of fathers reported that they had had such a rash, the majority of whom reported that they had had the rash sometimes rather than often.

2.4d. Hives
Hives (urticaria or nettle rash) is a skin reaction that causes itchy welts that range in size from small spots to large blotches.The reaction can be triggered by many situations and substances, including stress, certain foods and medications.
Immediately after the question on the dry itchy rash, the study fathers were asked whether they had had 'a blotchy blistery rash (hives) in the past two years'.There were very similar responses on each of the three occasions with about 3% saying that they had had such a rash.Only 0.4-0.5% claimed to have such a rash often, and the remaining 3% had stated they had had it sometimes (Table 2.4d).

Gastrointestinal problems 2.5a. Indigestion
Indigestion describes certain symptoms, such as abdominal pain and a feeling of fullness soon after starting eating, rather than a specific disease.However, it can also be a symptom of various digestive diseases.It was a relatively common problem among the fathers in the study and experienced by 27-41% within the previous year (Table 2.5aa).Less than 1% of the fathers, however, claimed to have had indigestion continuously in the past month (Table 2.5ab).
Both parents recorded whether the father had had indigestion and, if so, had consulted a doctor during 7 specific periods of time.Although 30-40% of fathers were reported to have the condition, in general <4% of the fathers had consulted a doctor for the problem (Table 2.5ac).

2.5b. Haemorrhoids
Haemorrhoids, or piles, are painful swollen veins in the anus and lower rectum, similar to varicose veins.Haemorrhoids were common in our study, with the proportion of fathers reporting they had ever had the problem increasing from 20% at the time of pregnancy to 30% after 8 -11 years (Table 2.5ba).The frequency with which they had occurred during the past month was asked on 7 occasions.They indicated a slight increase over time, from 7.3% at 21 months to 10.0% ten years later; relatively few fathers reported that the haemorrhoids were always present (Table 2.5bb).Mothers' reports of the fathers' haemorrhoids were proportionately very similar to those of the father himself (Table 2.5bc).

2.5c. Stomach ulcer
Stomach or peptic ulcers are open sores that develop on the inside lining of the stomach (gastric ulcers) and the upper portion of the small intestine (duodenal ulcers).The most common symptom of which is stomach pain.Only 3-4% of the study fathers reported ever having had such a disorder, and no more than 1% had had it in the previous year when asked in pregnancy, a proportion that was similar 8 and 11 years later (Table 2.5ca).Study mothers appeared to be more likely to know of the disorder in their partners if they had consulted a doctor for the problem (Table 2.5cb).

2.5d. Diarrhoea
Diarrhoea is generally defined as loose, watery and possibly more-frequent bowel movements.It is usually short-lived, lasting no more than a few days.But it can last into weeks; if so, it usually indicates that there is another problem.Our study fathers reported on seven occasions as to how frequently they had had diarrhoea in the preceding month.Very few ((<0.5%)recorded that this was occurring throughout the month (Table 2.5d).

2.5e. Nausea and Vomiting
Nausea and vomiting are common signs and symptoms that can be caused by numerous conditions.Although they are often due to viral gastroenteritis, many medications or substances can also cause nausea and vomiting, including marijuana (cannabis).
Fathers were asked about the frequency with which they had had each of the two symptoms in the previous month (Table 2.5e).Very few men (<0.2%) stated that they had such problems throughout the month, but 5-8% had nausea and 3-7% had vomited at some time during the month.

Cardiovascular features 2.6a. Hypertension
Hypertension is the name given to the presence of high blood pressure.This is not a disease in itself but increases the risk of heart disease and stroke.The prevalence is known to increase with age.
There were two occasions when the father was asked whether he had ever had hypertension, the age at which he had first had it, and whether he currently had it.The results are shown in Table 2.6aa.Eight years after the child's birth, 5.9% of the fathers reported that they had had high blood pressure; three years later this had increased to 9.0%.Similarly, the   point prevalence had increased from 3.1% to 4.7%.On both occasions the modal age at which hypertension was reported to have developed was 40; however, it should be noted that there was marked numerical bias with multiples of ten being particularly reported.
ALSPAC questionnaires also asked the father whether he had had high blood pressure (not specified) / hypertension within 4 specific times, but the mother was asked whether her partner had the problem on 7 occasions (Table 2.6ab).Both parents' reports indicated that the proportion of fathers with hypertension had increased by the time the study children were aged 9 or more.

2.6b. Chest pain
Chest pain is reported to appear in many forms, ranging from a sharp stab to a dull ache.It can be caused by many different conditions, the most notable being angina -a symptom of coronary heart disease caused by reduced blood flow to the heart.The questions asked of the parents in ALSPAC comprised those developed by Geoffrey Rose and colleagues (Rose et al., 1977).They used the questions to distinguish between angina, possible infarction and intermittent claudication.After using it on over 18,000 men they stated that the self-administered version of their questionnaire provided a simple and convenient means of identifying individuals with a high risk of major coronary heart disease.
The Rose questions were asked of the father at two time points (7 and 11 years after the study child was born).Similar proportions of the fathers reported ever having chest pain (25.8% and 26.2%) at the two time points (Table 2.6b).Further details as to the activities associated with the pain, severity of the pain and the number of occurrences can be obtained from the relevant 'built file' documentation in the ALSPAC Data Dictionary.It should be noted that the situation of the pain within the chest was marked on a diagram of the chest, and coded.Text descriptions of the diagnosis that had been given to the father are available, and the three different conditions can be derived from the questions using the criteria described in the paper by Rose and his colleagues.

2.6c. Diabetes
Diabetes mellitus refers to a group of diseases that affect the body's relationship with blood sugar (glucose).Glucose is vital to health as an important source of energy for muscles and tissues.It is the brain's main source of fuel.
Consequently, diabetes can have major effects on health and well-being.There are two types of diabetes -both can lead to excess sugar in the blood and can lead to serious health problems.Type 1 diabetes is the type that requires daily insulin to stabilise it and often develops in childhood, and type 2, which rarely occurs in childhood, can usually be controlled by diet and/or oral medication.
Both parents were asked whether the father had diabetes.
According to the mother only 0.3% of the fathers had diabetes shortly after the birth of the study child, but 11 years later the proportion had increased six-fold to 1.9%.The father was not asked directly about diabetes until the child was 5 years old, at which time 0.5% stated they were diabetic; 7 years later the prevalence had increased three-fold to 1.6% (Table 2.6ca).

2.6d. Varicose veins
Varicose veins are twisted, enlarged veins, most commonly affecting the veins in the legs.For many people, varicose veins are simply a cosmetic problem, but for others they can cause aching pain and discomfort.
The study fathers had an increasing prevalence of varicose veins with time -from 2.8% during the index pregnancy to 5.8% 11 years later (Table 2.6da).Additional data collected on 7 occasions concerned the frequency with which their varicose veins were present in the preceding month.These indicate that as the father got older, varicose veins became reported more frequently (Table 2.6db).

Renal conditions 2.7a. Kidney disease
Chronic kidney disease, also known as chronic kidney failure, involves a gradual loss of kidney function.Since the kidneys filter waste and excess fluids from the blood, which are then excreted in the urine, chronic kidney disease can cause dangerous levels of fluid, electrolytes and wastes to build up in the body.The fathers were asked on three occasions as to whether they had ever had kidney disease.Overall, there was little suggestion that the prevalence of such a history had varied from the 2.1% reported at the time of the study pregnancy (Table 2.7a).

2.7b. Urinary infection
Urinary tract infections encompass infections in any part of the urinary system (i.e.kidneys, ureters, bladder and urethra).However, most urinary infections involve the lower urinary tract (the bladder and urethra).Although women are prone to frequent urinary infections, it can be seen from Table 2.7ba and Table 2.7bb that when the preceding month was considered, the prevalence rarely exceeded 1% of fathers -and even when more extended periods of time were considered, only rarely did the condition occur as often as in 3% of fathers.

Psychiatric disorders 3.1a. Addictions
Substance addiction, also called substance use disorder, affects a person's brain and behaviour and leads to an inability to control the use of the drug or medication.Substances such as alcohol, marijuana and nicotine are considered such drugs.Few of the fathers reported that they had had a drug addiction (by which they may have interpreted the question to refer to illicit drugs only), and the proportion was higher at the time of the pregnancy (1.2%) than 8-11 years later (0.4% -0.5%) (Table 3.1aa).
Alcoholism, however, appeared to be more prevalent (Table 3.1ab); again, the reported prevalence was higher during pregnancy (2.9%) than later (1.5%).Information was collected on several occasions from both the mother and father.Of those who answered the questions the mothers reported a higher prevalence than the fathers did concerning their own alcohol problems.It is notable also that very few of the men with alcohol problems had consulted a doctor (Table 3.1ac).
(It is worth noting that there were questions throughout that identified the amount of alcohol being consumed by the study father, which were answered by both the mother and her partner).

3.1b. Depression
Depression is a mood disorder that causes a persistent feeling of sadness and loss of interest; it affects the way people feel, think and behave and can lead to a variety of emotional and physical problems.Data were collected from ALSPAC parents in two ways: (i) direct questioning concerning whether they felt depressed, and (ii) using a validated set of questions which have been used to develop a score, high    The direct questioning method was used with three different types of question: first, the father was asked on three occasions concerning severe depression ever, distinguishing between the preceding year, and prior to that (Table 3.1ba) -the proportions with severe depression were about 6% of fathers, the majority reporting previous episodes rather than recent ones; second, both mothers and fathers were asked concerning the presence of depression during a defined period of time, distinguishing between consulting a doctor or not (Table 3.1bb) -this showed a higher reported prevalence, particularly a higher proportion consulting a doctor; third, the point prevalence concerning the frequency of depression in the preceding month was reported (Table 3.1bc).
The Edinburgh Postnatal Depression Scale (EPDS; Cox et al., 1987) was selected by ALSPAC to be used for identifying depression among pregnant women.Others have shown that it is a valid instrument for use in men (Shafian et al., 2022).
It has been shown that, using a score of >12 to identify depression in ALSPAC parents postnatally identified 10% of mothers but only 4% of fathers as depressed (Ramchandani et al., 2005).
Others have used lower cut-points (e.g.10+ by Hibbeln et al., 2018).Massoudi et al. (2013) carried out a detailed validation study on men in Sweden and concluded that the EPDS is 'a valid instrument for screening for probable major depression, but it is questionable if it should be used to screen for minor depression.'More recently Shafian and colleagues (2022) carried out a systematic review and showed that cut points of 7-10 for fathers identified depression satisfactorily.Over the 12 years covered by this Data Note the scale was measured on 8 occasions from mid-pregnancy to 11 years after delivery.Table 3.1bd identifies the EPDS scores at the different time points and gives the proportions with scores exceeding 9 and 12. Details of the variables comprising the scale are given in the Data Note by Paul and Pearson (2020).

3.1c. Anxiety
People with anxiety disorders frequently have intense, excessive and persistent worry and fear about everyday situations.Often, anxiety disorders involve repeated episodes of sudden feelings of intense anxiety and fear or terror that reach a peak within minutes (panic attacks).These feelings can interfere with daily activities, are difficult to control, are out of proportion to the actual danger and can last a long time.
As with depression, experiences of anxiety were obtained using two methods: direct enquiry as to experiences of anxiety, and scores on a scale of questions that rate current levels of anxiety.
In regard to the direct questions, both the mother and the father were asked about the father's experience of anxiety (Table 3.1ca).This indicated that both reports were similar with mothers reporting prevalences that varied from 11% to 20% and fathers reporting from 14% to 22% at different time periods.
The scale used to measure anxiety in both the mothers and fathers used the sub-scale of free-floating anxiety, which is part of the Crown-Crisp Experiential Index (CCEI; Crown & Crisp, 1979).The original sub-scale had varying styles of response categories, some questions having a 2-point yes/no scale, while others had 3-point categories.ALSPAC modified the response categories for the study so that each item had 4 consistent response categories to which the respondent indicated frequency of symptoms from 'never' to 'very often'.These modifications were extensively pilot tested including a validation study against the Present State Examination (Thorpe, 1993).In a pilot study of a random sample of 54 pregnant women attending a routine check-up, Crown-Crisp index correlated 0.70 and 0.76 with the State and Trait (respectively) subscales of the Spielberger State-trait Anxiety Inventory (Heron et al., 2004).Over the 12 years covered by this Data Note the scale was measured on 8 occasions from mid-pregnancy to 11 years after delivery.
There is no standard cut-point used to identify clinically relevant anxiety.The proportions of fathers with scores over 5 and 7 are shown in Table 3.1cb.

3.1d. Eating disorders
Eating disorders can be serious conditions related to persistent eating behaviours that negatively impact health, emotions and ability to function.The most common of these are anorexia nervosa and bulimia nervosa.Men are far less prone to these disorders than women.The questions on anorexia and bulimia were asked on three occasions.Only bulimia had sufficient positive responses to present here (Table 3.1d).

3.1e. Other psychiatric problems
Fathers were asked whether they had any other psychiatric problems on 3 occasions (Table 3.1e).Fewer than 3% reported  such problems.They were described as text which can be accessed and coded directly by any interested researcher.

Neurological disorders 3.2a. Headache / migraine
Headache is pain in any region of the head.Headaches may occur on one or both sides of the head, be isolated to a certain location, radiate across the head from one point, or have a vicelike quality.A migraine is a headache that can cause severe throbbing pain or a pulsing sensation, usually on one Because there is often confusion concerning the distinction between headache and migraine, the ALSPAC fathers were usually asked about the occurrence of 'headache or migraine', although they were also asked about migraine itself.This showed a prevalence of 29-30% (Table 3.2aa) and little sense of any trend with time.For headaches and/or migraine, over half the fathers were reported to have been affected within the various periods of time, and this was consistent between the report of the father himself and of the mother's report (Table 3.2ab).The frequency with which the father had headaches during a one-month period (Table 3.2ac) shows that no more than 1% reported continual headaches, but that this rate did show a sign of increasing with time from 0.5% at 21 months to 1.0% at 12 years after the birth of the study child.

3.2b. Epilepsy
Epilepsy is a central nervous system (neurological) disorder in which brain activity becomes abnormal, causing seizures or periods of unusual behaviour, sensations and sometimes loss of awareness.At the time of the child's birth 1% reported a history of epilepsy, although fewer (0.2%) reported having it recently (Table 3.2b).

3.2c. Fatigue
Although most people are over-tired occasionally, unrelenting exhaustion, on the other hand, lasts longer, is more profound and cannot be relieved by rest.Study fathers were asked on 7 occasions how often they had felt exhausted in the past month.In general, this was reported to have occurred almost all the time by 3-4% of fathers (Table 3.2ca).
There was also a question on two occasions concerning a history of chronic fatigue syndrome (also known as CFS/ME) a disorder characterised by extreme fatigue which cannot be fully explained by an underlying medical condition.This was reported by 1.1 -1.3%, with 0.3-0.4% stating that it had been present within the past year (Table 3.2cb).

Other health conditions
A large number of mothers and the fathers reported other conditions that had occurred to the fathers over time (Table 4).These conditions have been stored verbatim as text responses and can be accessed for coding by bona fide researchers.

Strengths and limitations of the data on paternal measures of health
The participants recruited to the study were broadly representative of the general population of parents resident in the area at the time in terms of sex, ethnicity and socio-economic status (Fraser et al., 2013).The data described here can be linked to all the other data collected throughout the study.This includes information about the relationships between partners and the study child, biological markers from different members of the family, data regarding the parents' beliefs and behaviours,     physical and psychological environments, life experiences and demographics.Information was also collected from study fathers before and during the pandemic and is currently ongoing.The data can also be linked to data collected on fathers who were clinically examined in 2011-13 and will be able to be linked to details of ongoing clinical examinations (https://ahrp.blogs.bristol.ac.uk/).
In regard to the data collected on mental health, the scales used to measure depression and anxiety have been extensively used and validated.Nevertheless, as Reviewer 1 has pointed out, the EPDS has been criticized as not sufficient to modify the cut-off scores in fathers (as much as necessary) (Matthey, 2022).It is limited to evaluating depressive and anxious symptoms, without considering that fathers, and males in general, tend to manifest affective symptoms in a different way from mothers, for example with behavioural acting out and externalizing disorders (anger attacks, violent or dangerous conduct, compulsive physical or sexual activity, extramarital affairs, running away from home or at work, relationship conflicts).
Although there are now instruments that are better able to capture such manifestations of male depression, they were not available at the time that ALSPAC was designed.The benefit of the EPDS as used here is that the same instrument is measured over time.
Similarly, identification of physical disorders, although somewhat crude, have the advantage of being recorded over time using identical wording and, in addition, have the comparison of maternal report of her partner's disorders to compare with his own reports.
A limitation of this study is the lack of diversity, because at the time of enrolment, the population of Avon was mainly Caucasian, therefore there were too few Black, Asian and Minority Ethnic (BAME) participants (<6%) to allow for detailed analysis by ethnic background.In addition, as with all longitudinal studies, there is a loss to follow up over time, either through participants moving and failing to notify the study, dying or, rarely, withdrawing their consent for the study.In the latter case the data are removed.
In this paper we have described changes over time.However, the reader should be aware that the changes could be the result of differential response to the completion of the relevant questionnaires or due to a change of the mother's partner; however, these can be removed from relevant questionnaire time points using an appropriate variable in the PZ file (partner_ changed_when).It should also be emphasised that the reports are from the fathers and mothers.Whereas their reports are likely to be fairly accurate in regard to signs and symptoms, diagnoses are probably less accurate as they have not been validated by linkage to clinical records.
The influence of the father has been much neglected in considering the dynamics of the family over time, in contrast to the considerable amount of research that has considered the mother's health -particularly her mental health.By describing the measures of physical and mental health that are available we hope to encourage research into the ways in which aspects of the fathers' health contributes to the health and development of children and the well-being of mothers.We also are aware that these data will be important in the longterm follow-up of these fathers over time.

Open Peer Review
Current Peer Review Status: The data brief provides percentages of fathers in ALSPAC who were reported by themselves, or their partners (the mothers) to have physical problems, as determined subjectively, eight times between pregnancy (up to 8 months of child age) and child age 12 years.
Physical problems cover a wide range of symptoms, illnesses and ailments from arthritis to epilepsy, depression and fatigue.Frequencies are reported for mother and father responses combined and for all time periods combined.Thus some of the conclusions drawn are not justified by the data available to the reader -for example, whether mothers report physical problems more often than men do, or that reports of physical problems increase with age.
The data brief would be more valuable if, for each ailment, frequencies were given for reports by mothers and fathers separately, and by age.These additions would also show variations in responses over time.

Is the rationale for creating the dataset(s) clearly described? Yes
Are the protocols appropriate and is the work technically sound?Partly

Are sufficient details of methods and materials provided to allow replication by others? Partly
Are the datasets clearly presented in a useable and accessible format?
This article provides data from the Avon Longitudinal Study of Parents and Children (ALSPAC) study on paternal physical and mental health from pregnancy to 12 years after birth.The data presented are mainly descriptive which can be useful for researchers to link to other studies.It would be helpful to have more detail as to why this article has been written and how useful this information could be to inform or support other studies.Examples could be given for the different ways in which this dataset could be utilised.Although the authors have provided a brief explanation, I think this could be expanded further to make the importance of this dataset more explicit.
It would also be good to add some demographic details (i.e.age, education/occupation etc) of the fathers in the study to provide the readers with a better understanding of the sample.
Overall, I think this data note is an important addition to the information available from the ALSPAC study.A key feature of the ALSPAC is that it is one of the few longitudinal studies that also assesses the characteristics of the mother's partner (regardless of their gender or parental status).The study was carried out by administering self-report questionnaires from pregnancy up to the age of 12-13 of the children.
This article mainly illustrates the data relating to the physical and mental health of the mothers' partners (defined as study fathers).
The aim of the study is well introduced, the methodology is clearly described, satisfactorily defining the symptoms and pathologies studied.The description of the data is satisfactorily illustrated by numerous tables, even if not much space has been reserved for discussion.
Despite this, the authors are advised to integrate the text with some clarifications, to be possibly included within the limits of the study.
In the part dedicated to Psychiatric and Neurological conditions (pp.23-27) it is specified 1.
that maternal and paternal depression in ALSPAC were assessed with the use of the EPDS (p.25).Although this instrument has also been considered valid for screening for paternal perinatal affective disorders, it has also been criticized as not sufficient to modify the cut-off scores in fathers (as much as necessary) (Matthey, 2022).The EPDS is limited to evaluating depressive and anxious symptoms, without considering that fathers, and males in general, tend to manifest affective symptoms in a different way from mothers, for example with behavioral acting out and externalizing disorders (anger attacks, violent or dangerous conduct, compulsive physical or sexual activity, extramarital affairs, running away from home or at work, relationship conflicts).This requires the adoption of a gender-based perspective (Baldoni and Giannotti, 2020) using, if possible, validated tools developed for this purpose such as the Ddads Questionnaire (Vermeulen and Buyl, 2021) and the Perinatal Assessment of Paternal Affectivity (PAPA) (Baldoni et al., 2022).Obviously when the ALSPAC was designed and started (1991)(1992) this problem was not yet evident and sufficiently studied, but it could be at least mentioned and discussed within the limits of the study.
We appreciated that the study evaluated the possible addictions of fathers, an index associated with paternal affective disorders).Another useful data regarding Psychiatric and Neurological conditions, which can be added, if available, is whether the study fathers took psychotropic drugs and when.

2.
In conclusion, the article is of high scientific interest, well written, compliant with the scientific literature and could be published later after making the suggested additions.Reviewer Expertise: Attachment, Psychotherapy, Psychosomatics, Paternal perinatal affective disorders I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above.

Version 1 Reviewer
Report 18 July 2023 https://doi.org/10.21956/wellcomeopenres.20668.r58196© 2023 Richter L. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.Linda M. Richter 1 DSI-NRF Centre of Excellence in Child Development, University of the Witwatersrand, Johannesburg, South Africa 2 DSI-NRF Centre of Excellence in Child Development, University of the Witwatersrand, Johannesburg, South Africa Is the rationale for creating the dataset(s) clearly described?PartlyAre the protocols appropriate and is the work technically sound?YesAre sufficient details of methods and materials provided to allow replication by others?YesAre the datasets clearly presented in a useable and accessible format?YesCompeting Interests: No competing interests were disclosed.Reviewer Expertise: Men' transition to fatherhood, Paternal mental health, Health visiting/ child health I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard.Reviewer Report 14 July 2023 https://doi.org/10.21956/wellcomeopenres.20668.r59746© 2023 Baldoni F. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.Franco Baldoni 1 University of Bologna, Bologna, Italy 2 University of Bologna, Bologna, Italy The article, in accordance with the editorial lines of Wellcome Open Research, deals with updated data from the Avon Longitudinal Study of Parents and Children (ALSPAC), an important longitudinal study carried out in Avon, UK, on a population of over 14,000 mothers together to their partners (even non-biological fathers) and children.The study, which began in 1991-1992, has been previously documented by numerous articles.The goal was to assess how children's health, well-being and development was affected by the environment in which they grew up.

Environ
Res Public Health.2022; 19 (7).PubMed Abstract | Publisher Full Text 4. Vermeulen J, Buyl R, D'haenens F, Demedts D, et al.: The Development of the DDads Questionnaire: Awareness, Knowledge and Attitudes of the General Population Towards Paternal Depression.Front Psychiatry.2020; 11: 561954 PubMed Abstract | Publisher Full Text Is the rationale for creating the dataset(s) clearly described?Yes Are the protocols appropriate and is the work technically sound?Yes Are sufficient details of methods and materials provided to allow replication by others?Partly Are the datasets clearly presented in a useable and accessible format?Yes Competing Interests: No competing interests were disclosed.

Table 1 .1. General measures of health of study fathers as provided by the father and by the mother herself.
Preg = pregnancy; F & W = fit and well; N = no.completed.

Table 1 .3. Hospital admission (reason not specified) of father reported within life events inventory. Time asked Variable name N Period covered Yes % No %
N = no.completed

Table 2 .2ab. Frequency of wheezing with whistling on the chest in past 2 years by study fathers.
N = no.completed

Table 2 .2ac. Prevalence (%) of asthma or wheezing in study fathers and if so whether they consulted a doctor. Time asked Variable name N Period covered And consulted Dr. Not at all
N = no.completed

Table 2 .3aa. History of whether father had ever had hay fever distinguishing between recently (in past year) and prior to the past year only. Time asked Variable name N Yes No Recently % In past % Never %
N = no.completed

Table 2 .3b. Proportion of fathers reporting ever having an allergy.
n = no.with the allergy; -= not asked

Table 2 .5ab. Frequency (%) of indigestion in study fathers in the past month.
N = no.completed; *Question included an option ' once only'.This has been combined with 'sometimes'

Table 2 .5bb. Frequency (%) of haemorrhoids in study fathers in the past month.
N = no.completed; *Question included an option ' once only'.This has been combined with 'sometimes'

Table 2 .5d. Frequency (%) of diarrhoea in study fathers in the past month.
N = no.completed; *Question included an option ' once only'.This has been combined with 'sometimes'

Table 2 .6aa. History of hypertension as recorded on two occasions: at 8 and 11 years after the birth of the study child.
N = no.completed *Question included an option ' once only'.This has been combined with 'sometimes'

Table 2 .6b. Responses to questions concerning chest pain asked of the study fathers 7 years (PK) and 11 years (PP) after the study child was born. Time asked Variable name N Yes in past year % Yes but not in past year % No not at all %
N = no.completed

Table 2 .6ca. Prevalence (%) of diabetes in study fathers and if so whether they consulted a doctor. Time asked Variable name N Period covered And consulted Dr. Not at all
N = no.completed

Table 2 .6db. Frequency (%) of varicose veins in study fathers in the past month.
N = no.completed; *Question included an option ' once only'.This has been combined with 'sometimes'

Table 2 .7ba. Frequency (%) of urinary infection in study fathers in the past month.
N = no.completed; *Question included an option ' once only'.This has been combined with 'sometimes'

Table 2 .7bb. Prevalence (%) of urinary infection in study fathers and if so whether they consulted a doctor. Time asked Variable Name N Period covered And consulted Dr. Not at all
N = no.completed

Table 3 .1ab. History of whether father had ever had alcoholism distinguishing between recently (in past year) and prior to the past year.
N = no.completed levels of which have been shown to predict clinical levels of depression.

Table 3 .1ac. Prevalence (%) of alcohol problems in study fathers and if so whether they consulted a doctor.
N = no.completed

Table 3 .1bd. Continuous measures of the EPDS to assess current depression scores with proportions scoring over 9 and over 12.
N = no.completed

Table 3 .1bc. Frequency (%) of depression in study fathers in the past month.
N = no.completed; *Question included an option ' once only'.This has been combined with 'sometimes'

Table 3 .1bb. Prevalence (%) of depression in study fathers and if so whether they consulted a doctor.
N = no.completed

Table 3 .2aa. History of whether father had ever had migraine distinguishing between recently (in past year) and prior to the past year only.
N = no.completed

Table 3 .2ab. Prevalence (%) of headache or migraine in study fathers and if so whether they consulted a doctor.
N = no.completed

Table 4 . Prevalence (%) of other conditions in study fathers and if so whether they consulted a doctor. Time asked Variable name Period covered And consulted Dr. Not at all Yes %
N = no.completed

Table 3 .2cb. History of whether father had ever had chronic fatigue syndrome distinguishing between recently (in past year) and prior to the past year only.
N = no.completed